Diabetes is a major health problem for Native American People

The prevalence of diabetes varies among tribes, bands, pueblos, and
villages, and ranges from <5% to 50% for diagnosed diabetes. There are
more than 550 federally recognized tribes, bands, pueblos, and villages in
the United States (source: National Institute of Health). Indians,
on the average, are twice as likely to die from complications of diabetes than non-Indians.

What is diabetes?

Diabetes
means that your blood sugar is too high. Your blood always has some sugar
in it because the body needs sugar for energy to keep you going. But too
much sugar in the blood is not good for your health. Diabetes is NOT
contagious. Just because a friend or family member has diabetes, it does
not mean you can "catch it" from them!

How do you get high blood
sugar?

Your
body changes most of the food you eat into sugar. Your blood carries the
sugar to your body cells. The sugar needs insulin to get into the body
cells. Insulin is a chemical (a hormone) made in a part of the body called
the pancreas. The pancreas releases insulin into the blood. Insulin helps
the sugar from food get into body cells. If your body doesn't make enough
insulin or the insulin doesn't work right, the sugar cannot get into the
cells. It stays in the blood. This makes your blood sugar level high,
causing you to have diabetes.

The
signs of diabetes are:

being very thirsty

urinating often

feeling very hungry or tired

losing weight without trying

having sores that are slow to heal

having dry, itchy skin

losing feeling in the feet or having tingling in the feet

having blurry eyesight

You may have had one or more of these signs before you found out you had diabetes.

There are TWO types of Diabetes

People
can get diabetes at any age. Most people get diabetes when they are over
40 or 50 years old. They usually have the kind of diabetes called
non-insulin dependent diabetes. People with non-insulin dependent diabetes
follow a special diet and may take diabetes pills. However, sometimes they
need insulin shots. Some people get diabetes as children or teenagers.
They usually have the kind of diabetes known as insulin- dependent
diabetes. This means they need daily insulin shots.

Why you need to take care of your diabetes >

After a
number of years, diabetes can lead to serious problems in your eyes,
kidneys, nerves, gums and teeth, and blood vessels. The best way to take
care of your health is to work with your doctor to lower your high blood
sugar.

What is a good blood sugar level?

Everyone
has some sugar in their blood. The normal amount of sugar in the blood
ranges from about 70 to around 120 in people who don't have diabetes.
Blood sugar goes up after eating, but returns to the normal range in 1 or
2 hours. A good blood sugar range for most people with diabetes is from 70
to 150. This is before a meal--like before breakfast or 4 to 5 hours after
you last meal. Your blood sugar should be less than 200 about 2 hours
after your last meal.

How you can
take care of yourself if you have diabetes

Diabetes complications can be postponed or prevented by keeping the blood sugar in good control.

Blood sugar can be controlled by eating less fat and sugar and exercising more.

Eating less fat and sugar and exercising more may prevent diabetes.

Complications of Diabetes

Other complications:

Diabetes can
directly cause acute life-threatening events, such as diabetic
ketoacidosis* and hyperosmolar nonketotic coma.* People with diabetes are
more susceptible to many other illnesses. For example, they are more
likely to die of pneumonia or influenza than people who do not have
diabetes. * Diabetic ketoacidosis and hyperosmolar nonketotic coma are
medical conditions that can result from biochemical imbalance in
uncontrolled diabetes.

In 1996, an estimated 63,400 AIs/ANs
who receive care from IHS had diabetes; 98.3% were aged greater than or
equal to 20 years. Of those aged greater than or equal to 20 years, 49.7%
were aged 45-64 years; 59.0% were women. The prevalence of diabetes
increased with age -- from 3.5% for persons aged 20-44 years to 21.5% for
persons aged greater than or equal to 65 years. The overall crude
prevalence for those aged greater than or equal to 20 years was 9.0%. The
prevalence was greater among women (10.1%) than men (7.7%). The
age-specific prevalence among AI/AN women was higher than among men, but
the age-specific prevalence among non-Hispanic white men was higher than
among women.

Among
AIs/ANs aged 20-44 years and
45-64 years, the prevalence of diabetes was more than three times that
among non-Hispanic whites in the NHIS (3.5% versus 0.9% {95% confidence
interval (CI)=0.6%-1.2%} for persons aged 20-44 years and 19.0% versus
5.2% {95% CI=4.2%-6.2%} for persons aged 45-64 years). Among persons aged
greater than or equal to 65 years, the prevalence among AIs/ANs (21.5%)
was approximately twice that among non-Hispanic whites (11.4% {95%
CI=9.7%-13.1%}). The age-adjusted prevalence among persons aged greater
than or equal to 20 years was 2.8 times that among non-Hispanic whites in
the same age group (10.9% versus 3.9% {95% CI=3.5%-4.3%}).

The prevalence of diabetes varied by
tribal group -- 12.7% among the Plains tribes, 10.5% among the
Southwestern tribes, 9.3% among the Woodland tribes, and 4.5% among the
Pacific Coastal tribes. The age-adjusted prevalence of diabetes ranged
from 1.5 to 4.1 times the prevalence among non-Hispanic whites. Among the
tribes of the Plains and the Southwest, the age-adjusted prevalence of
diabetes (15.9% and 13.5%, respectively) was greater than that for the
total IHS population and was more than three times that among non-Hispanic
whites.

Prevalence

The prevalence of Type 2 diabetes in Native American communities has increased dramatically during the second half of this century.

Although many factors contribute to this marked increase, studies indicate that a trend away from traditional lifestyles in favor of westernization, with accompanying increases in body weight and diminished physical activity, is largely to blame.

Complications from diabetes are major causes of death and health problems in most Native American populations. Of equal concern is the fact that Type 2, or adult-onset diabetes, is increasingly being discovered in Native American youth.

Diabetes rates are highest in full-blooded Native Americans, as first observed in Choctaw Indians in 1965 and subsequently in other tribes. The prevalence of diabetes in residents of the Pima community in Arizona is the highest in individuals of full Native American heritage. About 50 percent of the tribe between the ages of 30 and 64 have diabetes. Prevalence of Type 2 diabetes among all Native American tribes in the United States is 12.2 percent of those over 19 years of age.

Risk Factors

As is the case with other high-risk populations, research indicates that there is a genetic basis behind the rise in prevalence of diabetes among Native Americans.

Obesity is a major risk factor for diabetes in many tribes, with increasing rates of obesity measured in several communities in the United Stated and Canada. This increase can be linked to the tribes� move away from traditional diets and lifestyles towards more modern ways of life. One notable study showed that Pima Indians who have adopted an �Anglo� diet are three times more likely to develop diabetes over six years than are their counterparts who eat a more traditional diet. The community now has the highest rate of Type 2 diabetes in the world. In addition, these studies have shown that there is a hereditary link. In the case of Arizona�s Pimas community, diabetes rates are highest in the offspring of parents who themselves developed diabetes at a young age. This trend has also shown up in studies of other tribes.

Complications

The serious complications of diabetes are increasing in frequency among Native Americans. Of major concern are increasing rates of kidney failure, amputations, and blindness.

Among people with diabetes, the rate of diabetic end-stage renal disease is six times higher among Native Americans.

Diabetes is the most frequent cause of non-traumatic lower limb amputations.

Amputation rates among Native Americans are 3-4 times higher than the general population.

Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. Diabetic retinopathy occurs in 18 percent of Pima Indians and 24.4 percent of Oklahoma Indians.

Solutions

In ideal circumstances, Native Americans with diabetes will have their disease under good control and be monitored frequently by a healthcare team knowledgeable in the care of diabetes. Because people with diabetes have a multi-system, chronic disease, they are best monitored and managed by highly skilled healthcare professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient.

Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their healthcare team. People with diabetes, with the help of their healthcare providers, should set goals for better control of blood glucose levels, as close to the normal range as possible for them.